Seke v Insurance Australia Limited t/as NRMA Insurance
[2023] NSWPICMP 360
•27 July 2023
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Seke v Insurance Australia Limited t/as NRMA Insurance [2023] NSWPICMP 360 |
| CLAIMANT: | Sanja Seke |
INSURER: | Insurance Australia Ltd t/as NRMA |
| REVIEW Panel | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Drew Dixon |
MEDICAL ASSESSOR: | Margaret Gibson |
| DATE OF DECISION: | 27 July 2023 |
| CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; injury on 22 February 2021; front seat passenger; original findings by Medical Assessor (MA) accepted; original MA found threshold injuries; Prior neck and right shoulder injuries; Subsequent MRI scan showed right shoulder tear not shown in pre-accident ultrasound scan; MRI scan more accurate and sensitive than an ultrasound scan; Panel not satisfied that claimant injured right shoulder as no medical reason why front seat passenger would injure that body part; fissure described in Lumbar MRI scan fissure as a possibility; finding probably degenerative; Panel satisfied that various injuries were threshold injuries; Held – original assessment confirmed. |
| DETERMINATIONS MADE: | Medical Assessment – Threshold injury Review Panel Assessment of Threshold Injury Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 The Review Panel confirms the certificate dated 2 January 2023 certifying that the claimant sustained threshold injuries. |
REASONS
BACKGROUND
Ms Sanja Seke (the claimant) sustained injury in a motor accident on 22 February 2021. The claimant was a front seat passenger when a truck entered into the lane and collided with the left side of the claimant’s vehicle.[1]
[1] Claimant’s bundle, p 40.
The insurer is liable to pay to Ms Seke any damages and/or statutory compensation entitlements under the Motor Accident Injuries Act 2017 (the MAI Act). The issue presently in dispute is whether Ms Seke’s physical injuries caused by the motor accident are a “threshold injury” within the meaning of the MAI Act.
The medical dispute referred for assessment listed the physical injuries as:
· cervical spine;
· thoracic spine;
· lumbar spine;
· both shoulders, and
· left leg.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor[2] and, pursuant to s 7.26 of the MAI Act, on review by a review panel.
[2] Section 7.20 of the MAI Act.
Medical Assessment
The medical dispute was referred to Medical Assessor Young who issued a Medical Assessment Certificate dated 2 January 2023 (the medical assessment). Medical Assessor Young found that the motor accident caused injuries to the cervical, thoracic and lumbar spine, both shoulders and the left leg which were all soft tissue injuries.
On examination the Medical Assessor found no signs of radiculopathy and a positive impingement sign at the left shoulder.
Amendment to legislation
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2023 with various amendments commencing on 1 April 2023. From
1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
The Medical Assessment was issued when the relevant term was minor injury which, because of the amendment, is now described as a threshold injury.
For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks.
Accordingly, an injury which does not fall within the definition of a threshold injury (a non-threshold injury) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26 week or 52-week limitation period.
The assessment by the Medical Assessor and the parties’ submissions were made prior to
1 April 2023 when the correct term was “minor injury”. Accordingly, the term “minor injury” and “threshold injury” are used in this assessment interchangeably as it reflects the relevant wording at the time of the submission and/or the medical assessment.
THE REVIEW
The claimant applied for a review of the medical assessment.
The President’s delegate referred the matter to the Review Panel (the Panel) as they were satisfied that there was reasonable cause to suspect that the medical assessment of minor injury was incorrect in a material respect having regard to the particulars set out in the application.[3]
[3] Section 7.26(5) of the MAI Act.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the medical assessment the subject of the review was made on or after 1 March 2021, the new
review provisions apply.The review provisions provide[4] that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
[4] Section 7.26(5A) of the MAI Act.
Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor.[5]
[5] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[6]
[6] Rule 128 of the PIC Rules.
The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[7]
[7] Section 7.26(6) of the MAI Act.
The parties filed bundles of documents for the Panel’s consideration.
The Panel issued the following further Direction:
“The Review Panel (the Panel) has met and observe that the submissions on review are directed to purported failure by the Medical Assessor to consider the MRI scans and treating records. No submission was made contesting the clinical findings.
The Panel is of the view that it can determine the matter on the papers if the clinical findings of the Medical Assessor are accepted by the parties.
The parties are to reply by close of business, 20 July 2023, whether they agree to this course.”
By email in reply the claimant consented to the matter proceeding on the papers. The insurer did not respond to the direction.
STATUTORY PROVISIONS
A threshold injury is defined in s 1.6 of the MAI Act and includes a “soft tissue injury” or a “psychological or psychiatric injury”. Section 1.6(2) of the Act defines a soft tissue injury to mean:
“[A]n injury to tissue that connects, supports or surrounds other structures or organs of the body (such as muscles, tendons, ligaments, menisci, cartilage, fascia, fibrous tissues, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage.”
Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulations) further defines threshold injury to include “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)”.
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a minor psychological or psychiatric injury caused by the motor accident.
5.4 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a)a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b)a review of all relevant records available at the assessment
(c)a comprehensive description of the injured person’s current symptoms
(d)a careful and thorough physical and/or psychological examination
(e)diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Clauses 5.7 to 5.9 of the Guidelines relate to whether an injury to a spinal nerve root in the context of neurological symptoms is classified as a threshold injury. An injury resulting in radiculopathy will not be classified as a threshold injury.
Clause 5.7 of the Guidelines provides:
“In assessing whether an injury to the neck or spine is a soft tissue injury, an assessment of whether or not radiculopathy is present is essential.”
Sections 5D and 5E of the Civil Liability Act 2002 apply to the MAI Act.[8]
SUBMISSIONS
Claimant’s submissions dated 1 February 2023[9]
[8] See s 3B(2) of the Civil Liability Act 2002.
[9] Claimant’s bundle, p 8.
These submissions were filed seeking a review of the medical assessment.
The claimant submitted that the Medical Assessor did not consider all materials including the MRI scans of the cervical and lumbar spine dated 10 June 2021 and the “complete set of treating doctor’s records obtained from the Bathurst Street Medical Practice”.
Insurer’s submissions dated 23 September 2021[10]
[10] Insurer’s bundle, p 107.
The insurer noted pre-existing conditions and submitted that the injuries were soft tissue injuries with no evidence that they would be considered non-minor injuries.
The insurer emphasised the prior right shoulder/neck condition and submitted that the accident could not have caused a right shoulder tear as the claimant was a front seat passenger and the tear shown on the MRI scan was “inconsistent with the mechanism of the accident”.
Insurer’s submissions dated 11 January 2023[11]
[11] Insurer’s bundle, p 2.
These submissions opposed the claimant’s application to review the medical assessment.
The insurer noted that the claimant’s review submissions “do not highlight how the outcome might have been materially differed had these records been considered”.
The insurer submitted that the possibility of an annular fissure at L5/S1 noted on imaging was more than likely pre-existing and an incidental finding.
It otherwise submitted that “the intervertebral disc is not cartilage and thus a fissure in this region” would not constitute a non-minor injury. It submitted that they are “connective tissue” joined to the vertebral endplate by a cartilage layer.
The insurer referenced the medical literature[12] included in this bundle that annular tears are more prevalent with the passage of time and was found in the asymptomatic population, disc height loss, disc bulges, disc protrusions and herniations and osteophyte complexes of the population.[13] The insurer highlighted that disc fissures of the annulus of all types are “presenting nearly in all degenerated discs” and “fissures occur in all degenerative discs but are not all visualised”. Notably, the term fissure is preferred over tear “primarily out of concern that the word “tear” could be misconstrued as implying a traumatic aetiology”.[14]
[12] Such as Boden et al, Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects, A prospective investigation. JBJS, 72(8), 1178-1184; Coroneous M, Incidence, Evaluation and Classification of lumbar spine MR abnormalities in asymptomatic individuals.
[13] Insurer’s bundle, p 3.
[14] Insurer’s bundle, p 3.
The insurer, after referring to the various literature submitted:[15]
“In short, the medical literature evidences (sic) that disc degeneration commencement occurs from early on in life later compounded with minor traumatic or repetitive occupational events. Such imaging findings, including complete sacralisation, disc dehydration and radial annular are highly unlikely to represent any new structural change. Most new changes such as disc signal, facet osteoarthritis and endplate signal changes represent progressive age-related changes not associated with acute events.”
MATERIAL BEFORE THE REVIEW PANEL
Pre-accident medical records
[15] Insurer’s bundle, p 4.
In May 2018 the claimant was off work for one month due to a low back injury. [16]
[16] Claimant’s bundle, p 73.
Various records refer the claimant undergoing physiotherapy and being off work in September/October 2018 for a right leg injury.[17]
[17] Claimant’s bundle, p 45.
The claimant injured her right shoulder and neck in a work accident in January 2020 and was certified unfit for work on a number of occasions throughout 2020 and into 2021.[18] An ultrasound showed subacromial bursitis but no sign of high-grade rotator cuff tear.[19] A right shoulder injection was undertaken without complications.[20]
[18] Claimant’s bundle, pp 148 - 223.
[19] Claimant’s bundle, p 124.
[20] Claimant’s bundle, p 128.
Regular physiotherapy to the right shoulder and neck occurred throughout 2020. The recent request prior to the motor accident was on 5 February 2021 when the physiotherapist noted right shoulder and neck pain.[21]
[21] Claimant’s bundle, p 214.
Post- accident medical records
The clinical note of the general practitioner dated 23 February 2021 referred to the motor accident with complaints of pain in the neck, upper and lower back, both shoulders and a big bruise on the left leg.[22] A certificate of capacity dated 26 April 2021 was consistent with the clinical note.[23]
[22] Claimant’s bundle, p 40.
[23] Claimant’s bundle, p 137.
A physiotherapist plan dated 7 April 2021 related to injuries under the 2020 workers compensation claim to the right shoulder and neck.
The claim form dated 1 May 2021 noted the following injuries caused by the motor accident:[24]
“Have pain from the accident in my neck, left shoulder, upper and lower back and left leg.”
[24] Claimant’s bundle, p 238.
In the claim form the claimant reported pre-existing conditions to the right shoulder, leg and right side of neck.
The MRI scan of the cervical spine was normal with a mild central disc bulge at C6/7 without any foraminal narrowing or canal stenosis.[25] The MRI scan of the lumbar spine was normal with no significant disc bulge, canal stenosis or foraminal narrowing. There was a linear area of T2 high signal deep to the posterior margin of the L5/S1 disc which raised the possibility of an annular fissure.
[25] Claimant’s bundle, p 258.
The MRI scan of the right shoulder dated 9 July 2021 showed an interior mid bursal side partial-thickness supraspinatus tear with no muscle belly atrophy.[26]
[26] Claimant’s bundle, p 39.
Medical literature
The insurer included a number of articles.
Biomechanics of the human intervertebral disc: A review of testing techniques and results[27]
[27] Insurer’s bundle, p 8
The article noted that “intervertebral discs (IVDs) are pads of fibrocartilage which lie between the vertebrae of the spine”[28] and when physically disruptive can lead to chronic back pain. The annulus fibrosis (AF) is made up of between 15 and 25 concentric layers (the lamellae) and each layer consistent of strong collagen fibre bundles “as in tendon”.
[28] Insurer’s bundle, p 6.
What is intervertebral disc degeneration, and what causes it?[29]
[29] Insurer’s bundle, p 21.
Factors, such as genetics, aging, and impaired metabolite transport, can weaken the disc and make it more vulnerable to damage, but do not necessarily cause degeneration on their own. The authors also note that mechanical loading, such as compression, bending, and torsion, can cause all of the major structural features of disc degeneration, and that injury or wear-and-tear can contribute to the process.
Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects[30]
[30] Insurer’s bundle, p 32.
The study focused on the prevalence of abnormal findings on magnetic resonance imaging (MRI) of the lumbar spine in asymptomatic individuals. The study found that about 30% of the asymptomatic population had a major abnormality on MRI, and that the incidence of abnormalities on MRI is age dependent. The study also suggests that relying solely on diagnostic tests such as MRI, without clinical information, is dangerous and can lead to inappropriate surgical interventions. The study also discusses the prevalence of bulging and degenerated lumbar intervertebral discs seen on MRI in asymptomatic individuals, and how these findings are part of a normal, or at least common, aging process.
Incidence, evaluation and classification of lumbar spine MR abnormalities in asymptomatic individuals[31]
[31] Insurer’s bundle, p 38.
An annular bulge represents broad-based annular laxity due to annular Sharpey fibre loss of lamellation and tearing or fissuring, due to degeneration with associated nuclear desiccation and facet OA changes. A focal protrusion of the annulus with the length of the height exceeding that of the base is more properly termed a 'prolapse' or 'herniation'. The 'prolapse' or 'herniation' represents a full-thickness annular defect with nucleus pulposus herniation into the annulus, sub/intraligamentous or epidural spaces. It is also more commonly due to degeneration but can also have a traumatic aetiology.
Annular tears and disc herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica[32]
[32] Insurer’s bundle, p 43.
This study suggests that annular tears in the spine are frequently found in asymptomatic individuals, with a reported prevalence of 40-75% in those between the ages of 50 and 70 years. While tears may not always be symptomatic, they can potentially irritate nerve endings and cause pain. The study suggests that high-signal-intensity zones on T2-weighted MR images are a reliable marker of discogenic pain, with a 86% positive predictive value for painful discography in symptomatic patients. However, the study also found a high prevalence (47%) of hyperintense annular tears on T2-weighted images in their asymptomatic population, suggesting that the relationship between this finding and symptoms is dubious.
The study also found that contrast enhancement in the central part of the annular tear was recognized in 96% of the 28 discovered annular tears, suggesting that this finding is likely to be an incidental finding in symptomatic patients. Enhancement of the annuloligamentous complex was suspected in one (4%) of the 28 cases of discovered annular tears. The study found no correlation between the discovery of annular tears and the history of low back pain or sciatica.
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations[33]
[33] Insurer’s bundle, p 49.
Imaging findings of degenerative changes in the spine, such as disc degeneration, disc signal loss, disc height loss, disc protrusion, and facet arthropathy, are generally part of the normal aging process rather than pathologic processes requiring intervention. The text also indicates that degenerative changes observed on imaging, such as CT and MR imaging, are often seen with normal aging and are not necessarily associated with the degree or the presence of low back pain.
Shock over disc degeneration in 10-year olds—but are disc abnormalities in this age group surprising?[34]
[34] Insurer’s bundle, p 56.
This article discusses a study conducted in Scotland that found degenerative changes in the lumbar discs of asymptomatic 10-year-old children. The study revealed that 9% of the children had a disc abnormality, and 14 of the children showed one abnormal disc at either the L4/5 or L5/S1 levels.
Lumbar disc nomenclature: version 2.0 Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology[35]
[35] Insurer’s bundle, p 59.
The authors argue that the term "tear" should be discouraged because it can be misunderstood as indicating injury, whereas "fissure" is a more appropriate term. They define herniation as a localized or focal displacement of disc material beyond the limits of the intervertebral disc space, which may be classified as protrusion or extrusion based on the shape of the displaced material.
The document also discussed various forms of loss of integrity of the annulus, such as radial, transverse, and concentric fissures. It notes that annular fissures are present in nearly all degenerated discs and should be described as such rather than "tears," which could be misconstrued as implying a traumatic aetiology. The classification of "degenerated disc" includes all changes associated with pathologic degenerative processes in the disc and does not differentiate between these changes and those of normal aging.
Does minor trauma cause serious low illness?[36]
[36] Insurer’s bundle, p 80.
The authors noted that in the absence of major trauma, chronic low back pain has been shown in in previous studies to be correlated with psychosocial issues, other chronic pain process and mental health issues. It concluded that minor trauma did not appear to increase the risk of serious low back pain or disability. The vast majority of adverse low back pain events were not associated with changes in structural findings but with demographic and behavioural variables.
FINDINGS
The review is a new assessment of all matters with which the medical assessment is concerned. The medical assessment related to the injuries sustained in the motor accident were minor or non-minor (now threshold or not threshold) as defined under the MAI Act.
The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[37] and Insurance Australia Ltd v Marsh.[38] In the present case the claimant accepted that the examination findings of the Medical Assessor. The examination findings are set out in paragraph 14 of the medical assessment[39] which we adopt but have not repeated in these reasons.
[37] [2021] NSWCA 287 at [40], [41] and [45].
[38] [2022] NSWCA 31 at [11], [21] and [64].
[39] Claimant’s bundle, pp 19-21.
We adopt the reasoning in Lynch v AAI Ltd[40] that the claimant bears the onus of proof in establishing that any injury is not a threshold injury for the purposes of the MAI Act.
[40] [2022] NSWPICMP 6 at [44]-[62].
The claimant in its review submissions emphasised the MRI scan of the lumbar spine and the “complete set of treating doctor’s records obtained from the Bathurst Street Medical Practice”. He did not specify how the latter records established that there was a non-threshold injury.
We refer to the lumbar MRI scan later in these reasons. We have otherwise considered the clinical records of the general practitioner but could not locate any specific record that established the claimant’s contention that she sustained a non-threshold injury.
Lumbar spine
The MRI scan of the lumbar spine dated 10 June 2021 was normal save as to the following comment:[41]
“There is a linear area of T2 high signal just deep to the posterior margin of the L5/S1 disc, raising the possibility of a tiny annular fissure. The clinical significance of this is uncertain, in view of a stated history of radiculopathy.”
[41] Claimant’s bundle, p 258.
The MRI scan refers to the “possibility” of a tiny annular fissure and is not definitive. The clinical findings of the original Medical Assessor do not relate the low back symptoms to a tiny annular fissure.
The material referenced by the insurer noted that degenerative changes in the lumbar spine are more prevalent with age. It is otherwise extremely unlikely that a modest collision would cause an annular fissure in the low back. The low back is protected by the seat and the forces imposed on that body part are modest and indirect.
As the findings of the original Medical Assessor show, there were no neurological signs of radiculopathy. Previous complaints of leg pain referenced in the clinical records are not objective signs of radiculopathy as defined in the Guidelines.
We are satisfied that the claimant sustained a soft tissue injury to the low back which is a threshold injury as defined in the MAI Act.
Cervical spine
The MRI scan of the cervical spine dated 10 June 2021 showed no evidence of disc bulge save at C6/7 where there was “a very mild central disc bulge” with no canal stenosis or foraminal narrowing.[42] Those findings are essentially normal.
[42] Claimant’s bundle, p 258.
There is no basis to find that there are any symptoms and/or radiological findings in the cervical spine that could support a finding that the claimant sustained a non-threshold injury. There are otherwise no signs of radiculopathy as defined in the Guidelines from the cervical spine. We are satisfied that the claimant suffered a threshold injury to the cervical spine.
Thoracic spine
There are no scan findings showing traumatic changes in the thoracic spine. Based on the clinical findings of the Medical Assessor we agree that the claimant sustained a soft tissue injury of the thoracic spine which resolved.
Right shoulder
The claimant was suffering from right shoulder symptoms for over a year prior to the motor accident. Indeed, the claimant continue to have physiotherapy for the right shoulder and neck after the motor accident under a physiotherapy plan paid by the workers compensation insurer for the 2020 work injury.
The pre-accident ultrasound did not show a tear in the right shoulder although a subsequent MRI scan taken after the motor accident showed an interior mid bursal side partial-thickness supraspinatus tear.
An ultrasound may not show a tear as it is not as accurate and sensitive as an MRI scan. An ultrasound is otherwise highly dependent upon the reporting by a radiologist.
It is not medically plausible that the right shoulder could be injured in the circumstances described by the claimant where she was a front seat passenger with no internal trauma onto the right shoulder. As a front seat passenger there were no indirect forces through the seatbelt on the right shoulder.
The claimant did not report in the claim form that she injured her right shoulder in the motor accident and noted that this body part was a pre-existing condition. The statement in the claim form only supports the Panel’s view that there was no plausible medical basis that the motor accident caused a right shoulder injury.
We are not satisfied that the motor accident caused a right shoulder injury.
Left shoulder
The claimant reported left shoulder symptoms caused by the motor accident in the claim form.
There is no scan evidence showing injury to nerves or a complete or partial rupture of tendons, ligaments, menisci or cartilage of the left shoulder.
The mechanism of injury to the left shoulder from a rear end collision is not explained in the medical evidence although there may have been some indirect injury to the left shoulder through the seatbelt as the claimant was a front-seat passenger. The nature of the forces causing trauma in this manner would have been modest.
The clinical findings for the left shoulder made by the Medical Assessor are otherwise consistent with the claimant sustaining a soft tissue injury. The shoulder impingement noted by the Medical Assessor is consistent with inflammation in the subacromial joint. Inflammation in the joint does not result on a finding of a non-threshold injury.
We are satisfied that the claimant suffered a threshold injury to the left shoulder.
Left leg
We accept that the claimant suffered a muscular injury to the left leg evidenced by the various clinical records. This is a soft tissue injury as defined in the MAI Act which means that it is a threshold injury.
CONCLUSION
For these reasons the Panel concludes that the certificate issued by Medical Assessor Young is confirmed.
A new certificate is attached at the commencement of these Reasons which is slightly reworded by using the term threshold injury.
1
3
0